Composite Bone Cement Arthrodesis In Acrometastasis Of The Proximal Phalanx Of The Hand– A Case Report

Bone metastases to the hand are extremely rare with a reported incidence rate of approximately 0.1% of all metastatic lesions to the bone (1, 10, 11). The appearance resembles an acute infection and is often mistaken for more common hand sequela (3, 13-15,) even when a primary malignant tumor is known. Acrometastases usually develop late in the course of tumor seeding and are associated with a low life expectancy (5). Treatment is palliative with focus on pain relief and improvement of hand function in order to maintain the patients independency. For distal lesions, amputation is the treatment of choice. Suggested treatment for proximal metastases consists of systemic therapy and/or radiation with or without local excision. A radical resection requires amputation of a significant part or the hand (3, 6). The concept of palliative tumor surgery with local tumor resection and bridging of the defect with a cement osteosynthesis is widely accepted for the long bones. This case presents an attempt to resect a painful acrometastasis to the proximal phalanx and provide stability by a composite cement arthrodesis of the metacarpophalangeal joint in order to avoid amputation.